Provider Demographics
NPI:1063412831
Name:HRISTON-ZECH, ELAINE (RPT)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:HRISTON-ZECH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5330
Mailing Address - Country:US
Mailing Address - Phone:203-966-5752
Mailing Address - Fax:
Practice Address - Street 1:45 GROVE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5330
Practice Address - Country:US
Practice Address - Phone:203-966-5752
Practice Address - Fax:203-966-7507
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT02654225100000X
NYNY2561352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTANC1555OtherOXFORD
CT080002635CT01OtherANTHEM BLUE CROSS BLUE SH
CT65000049Medicare ID - Type Unspecified